| NPI | 1114678380 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363A00000X Physician Assistant (Licence: MT MED-PAC-LIC-117415) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2022-01-10 |
| Last Update Date | 2023-05-01 |